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href=\u0022https:\/\/www.bmj.com\/sites\/default\/files\/advagg_css\/css__-BkZ71IF4pBXmZfP4vYyswWdIhuaKktrUUQ4i2vtUVo__0i_0YcYkMECNn0z7FdhNoJ8gLWleqnTtjnHRAmLijvc__b2e6faiQ_UWIrIhhy-1_GBi9M1f1xMsmWzx8NA2PKwk.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-bmj-related-rapid-responses\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-views-panes pane-bmj-rapid-responses-bmj-rr-article\u0022 \u003E\n \n \u003Ch2 class=\u0022pane-title\u0022\u003EAll rapid responses\u003C\/h2\u003E\n \n \n \u003Cdiv class=\u0022pane-content\u0022\u003E\n \u003Cdiv class=\u0022view view-bmj-rapid-responses view-id-bmj_rapid_responses view-display-id-bmj_rr_article view-dom-id-ac6b6a30898d814e7eae6b11f8b531f4\u0022\u003E\n \u003Cdiv class=\u0022view-header\u0022\u003E\n \u003Cdiv id=\u0022response-header-description\u0022\u003ERapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. \u003Cem\u003EThe BMJ\u003C\/em\u003E reserves the right to remove responses which are being wilfully misrepresented as published articles.\u003C\/div\u003E \u003C\/div\u003E\n \n \u003Cdiv class=\u0022view-filters\u0022\u003E\n \u003Cform action=\u0022\/\u0022 method=\u0022get\u0022 id=\u0022views-exposed-form-bmj-rapid-responses-bmj-rr-article\u0022 accept-charset=\u0022UTF-8\u0022\u003E\u003Cdiv\u003E\u003Cdiv class=\u0022views-exposed-form\u0022\u003E\n \u003Cdiv class=\u0022views-exposed-widgets clearfix\u0022\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-widget-sort-by\u0022\u003E\n \u003Cdiv class=\u0022form-type-select form-item-sort-by form-item form-group\u0022\u003E\n \u003Clabel for=\u0022edit-sort-by\u0022\u003ESort by \u003C\/label\u003E\n \u003Cselect class=\u0022form-control form-select\u0022 id=\u0022edit-sort-by\u0022 name=\u0022sort_by\u0022\u003E\u003Coption value=\u0022field_highwire_a_epubdate_value\u0022 selected=\u0022selected\u0022\u003EDate Published\u003C\/option\u003E\u003C\/select\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-widget-sort-order\u0022\u003E\n \u003Cdiv class=\u0022form-type-select form-item-sort-order form-item form-group\u0022\u003E\n \u003Clabel for=\u0022edit-sort-order\u0022\u003EOrder \u003C\/label\u003E\n \u003Cselect class=\u0022form-control form-select\u0022 id=\u0022edit-sort-order\u0022 name=\u0022sort_order\u0022\u003E\u003Coption value=\u0022ASC\u0022\u003EAscending\u003C\/option\u003E\u003Coption value=\u0022DESC\u0022 selected=\u0022selected\u0022\u003EDescending\u003C\/option\u003E\u003C\/select\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-widget-per-page\u0022\u003E\n \u003Cdiv class=\u0022form-type-select form-item-items-per-page form-item form-group\u0022\u003E\n \u003Clabel for=\u0022edit-items-per-page\u0022\u003EItems per page \u003C\/label\u003E\n \u003Cselect class=\u0022form-control form-select\u0022 id=\u0022edit-items-per-page\u0022 name=\u0022items_per_page\u0022\u003E\u003Coption value=\u00225\u0022\u003E5\u003C\/option\u003E\u003Coption value=\u002210\u0022 selected=\u0022selected\u0022\u003E10\u003C\/option\u003E\u003Coption value=\u002220\u0022\u003E20\u003C\/option\u003E\u003Coption value=\u002240\u0022\u003E40\u003C\/option\u003E\u003Coption value=\u002260\u0022\u003E60\u003C\/option\u003E\u003C\/select\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-submit-button\u0022\u003E\n \u003Cinput class=\u0022btn btn-info form-submit\u0022 type=\u0022submit\u0022 id=\u0022edit-submit-bmj-rapid-responses\u0022 name=\u0022\u0022 value=\u0022Apply\u0022 \/\u003E \u003C\/div\u003E\n \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003C\/form\u003E \u003C\/div\u003E\n \n \n \u003Cdiv class=\u0022view-content\u0022\u003E\n \u003Cdiv class=\u0022views-row views-row-1 views-row-odd views-row-first\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment node-promoted clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/content\/366\/bmj.l5290\/rr-0\u0022\u003E\u003Ch3\u003ERe: Medical cannabis: patients turn to private clinics because of NHS void\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cp\u003EThere is a mystifying narrative in this article that states that while NHS doctors follow guidelines (and good prescribing behaviour), those who choose to work privately can simply disregard safety, evidence and the law and give out cannabinoids at will because they know better.\u003C\/p\u003E\n\u003Cp\u003EThere are plenty of interested groups in the UK pushing for medical cannabis on prescription but in the face of anecdote and commercial pressure the job of doctors and the BMJ is to use scientific evidence as the bedrock of good prescribing practice and balanced journalism respectively. NICE has produced its guidance because it has looked at the evidence, and the NICE guidance ought to be the underpinning message here. Instead your article reads as a puff-piece for interested concerns who stand to make money and reputation from cannabis. You may think you have created balance by detailing the extensive commercial conflicts of interest of your two cannabinoid promoting interviewees, but that simply reads as two pages of free advertising for Drs Sodergren and Barnes. Well done them!\u003C\/p\u003E\n\u003Cp\u003EFor your information, if cannabinoids were shown to be effective, they would be prescribed as of Nov 2018. But the strongest scientific evidence fails to show any meaningful benefit for cannabinoids across a range of conditions. Until the evidence changes, those of us who understand the guidance and who see biased opinion for what it is, will not be in a position to prescribe cannabinoids.\u003C\/p\u003E\n\u003Cp\u003EFinally I won\u2019t be the only NHS doctor reading the article who is more than a little insulted at the implication that I would prescribe cannabis if only I was properly educated. We can all access and evaluate the same knowledge base. Those of us who do no private practice and who have no research, professional or commercial ties to cannabinoid companies or clinics, can evaluate the knowledge base without conflicts of interest. Surely that makes us more educated?\u003C\/p\u003E\n\u003Cp\u003EThe BMJ positions itself as a promoter of good medical practice, free of bias, but in this instance you have let down your editorial guard.\u003C\/p\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n No competing interests\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E12 September 2019\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n Ivan L Marples \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n Consultant in Pain Medicine \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n Lothian Health Board \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n Pain Clinic, Leith Community Treatment Centre, Edinburgh \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/\u0022\u003E\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-row views-row-2 views-row-even views-row-last\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment node-promoted clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/content\/366\/bmj.l5290\/rr\u0022\u003E\u003Ch3\u003E The new thalidomide? Re: Medical cannabis: patients turn to private clinics because of NHS void\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cp\u003EThe UK National Institute for Health and Care Excellence has proposed GPs and other prescribers such as pharmacists and nurses should be able to take on prescribing of cannabis based medicinal products once initiated by specialists in expert centres.1 NICE cautions against the use of medical cannabis because of lack of evidence of safety. It is good that GPs are being cautious about prescribing cannabis. \u003C\/p\u003E\n\u003Cp\u003EThere may be little evidence of long term benefit but there is a wealth of evidence of serious harmful effects. Reece and Hulse published a review of the impacts of cannabinoid epigenetics on human development which is very alarming.2 Cannabis use increases hyper-and hypo DNA methylation of sperm in rats and in humans which may provide a vector for the transmission of transgenerational instability. Cannabis-related teratology includes effects on the neuraxis, cardiovasculature, immune stimulation, secondary genomic instability and carcinogenesis related to paediatric and adult cancers. Trends in the USA, Hawaii, Colorado, Canada, France and Australia relate to mental retardation, and inheritable carcinogenesis.\u003C\/p\u003E\n\u003Cp\u003EThe outlook for future generations is bleak when fathers have sperm with epigenetic cannabinoid-induced damage and mothers have also taken cannabis before or even during pregnancy. Cannabinoids may be the new thalidomide. As usual powerful drugs are being given with few, if any, checks on the effects on crucial basic biochemistry such as levels of copper and zinc and blood metallothionein.\u003C\/p\u003E\n\u003Cp\u003E1 NICE. Cannabis-based medicinal products: draft guidance for consultation. Aug 2019. \u003Ca href=\u0022https:\/\/www.nice.org.uk\/guidance\/indevelopment\/gid-ng10124\/consultation\/html-content-2\u0022\u003Ehttps:\/\/www.nice.org.uk\/guidance\/indevelopment\/gid-ng10124\/consultation\/...\u003C\/a\u003E.\u003C\/p\u003E\n\u003Cp\u003E2 Reece AS, Hulse GK. Impacts of cannabinoid epigenetics on human development: reflections on Murphy et. al. \u0027cannabinoid exposure and altered DNA methylation in rat and human sperm\u0027 epigenetics 2018; 13: 1208-1221. Epigenetics 2019 Jul 11:1-16. Epub 2019 Jul 11.\u003C\/p\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n No competing interests\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E06 September 2019\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n Ellen CG Grant \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n Physician and medical gynaecologist \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n Retired \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n Kingston-upon-Thames. 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